Preoperative patient evaluation.

Screening laboratory testing seemed logical: if you could spot abnormalities before overt disease occurred, you could prevent disability. But it has not worked out that way for the majority of preoperative tests. We are now spending over $40 billion a year in the United States on preoperative testing and evaluation; 60 per cent of it is wasted. This is like saying, "If a little epinephrine is good, more is better." That is wrong in the use of epinephrine and it can be wrong with too much testing. Worse than wasteful, I believe this extra testing is causing iatrogenic disease by pursuit and treatment of borderline and false-positive test results. It is increasing our medicolegal risk and decreasing the efficiency of practice. Fortunately, this history of too much testing can now be turned to our advantage. It provides an arena where we can demonstrate to our constituency, the patient, and our watchdog, the bureaucrat, that we can use inexpensive technology to reduce costs substantially and improve the quality of care.